MEDICARE: MR. KENNETH L GRAVES (LMSW)

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	046572-01	NY

General Provider Information

NPI Number	:	1619605623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH L GRAVES (LMSW)

Provider Business Mailing Address
First Line	:	826 COLUMBUS AVE APT 11G
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-4506
Country	:	US
Telephone Number	:	212-837-2711
Fax Number	:

Provider Business Practice Location Address
First Line	:	826 COLUMBUS AVE APT 11G
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-4506
Country	:	US
Telephone Number	:	212-837-2711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2022
Last Update Date	:	08/09/2022

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Directions to “ MR. KENNETH L GRAVES (LMSW)” Practice Location

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